1700 13TH ST 1ST FLOOR 2022-05-16

- laz z EWCTRICAL PERMIT APPLICWION EVERETT 32 CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: i 71 O C. i�Z ' 3 1'z ct-k' IVA cieLtr i BUILDING AREA: _sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION El TENANT IMPROVMENT REMODEL BUILDING USE: El SFR El TOWNHOUSE ❑ DUPLEX El ADU El MULTI-FAMILY-#OF UNITS: R1 COMMERCIAL ELECTRICAL APPLICATION INFORMATION & DESCRIPTION OF WORK CONTRACT PRICE OF WORK:$ / L ASSOCIATED BUILDING PERMIT#(if applicable): 1 'd( DESCRIBE SCOPE``OF WORK: D~c:;:,5 ��_/ C tZi.ti L 1 hi ; Lite, Cnt1c.\ t`th iLef>lGtCv,,.G-vr-F %c- rim rMc::'ir-:S filL.c.fni �'t C 'VL L:i✓►`•S ' Q. of $2 (✓,g / THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? IN NO ❑YES-Select Scope: ❑ Service ❑ Feeder ❑Circuits-#: ❑ Complete Re-wire LOW VOLTAGE WORK? SINO El YES-#of Devices: SELECT SCOPE(REQUIRED): ❑ Data ❑ Intercom Cl Thermostat ❑Audio El Secure Access ❑ Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. E Other(List All): CODE COMPLIANCE IS THIS PERMIT EDUCATION,INSTITUTIONAL, HEALTH AND/OR PERSONAI-CARE FACILITIES: El NO YES--See Below&Pg. 2 By checking this box,I am stating that I have read and understand all of WAC 296.46E-900,selecte the specific reason+on page 2 of this application(see next page),AND Plan Review is NOT required because I meet all of the following sub sections that do not See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ENO EYES-See Below&Pg.3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent,sale,or lease without the proper electrical licensing and certification,or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. CONTACT INFORMATION OWNER NAME: e L':Cit Y«- c'-;„w4: /leit;cc;..1 TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1 e c i Li 4d AC 5'tJ /�7/1/4, CITY o't i'L:vk STATE ift:'H 21P ,fi OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Vcr 4 r is&I L- r c 6. c✓I,lc ic,- ‘1/2 Z-c-c_ CONTRACTOR ADDRESS: STREET - '7 /jt `�j CITY Sec:-l/c. STATE £1 J 4 ZIP , /c CONTRACTOR PHONE:1:2c • `i3(i.-- 7 2-`L' CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): V r(;t}aG%-- i t✓. CZ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Cc - ''4'S PRIMARY CONTACT: DOWNER ❑CONTRACTOR gOTHER(Please Specify) C i-t d 6,,, ;s1.1 Ili c;,14,"7 CONTACT NAME: CONTACT PHONE: Z 4 • . ., `-y'j .', .��`1/4'-DC`� tLR--44,r..A.i e ( CONTACT EMAIL: ;...0s, , Sc"ft,-,:, t,.,c.l c( i✓i tc"fit.1, (✓e."'"N AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances go✓erning this type of work will be completed whether specified herein or not. she granting of a permit does not presume to give authority to violate or cancel the provisions of ar1Y other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT ti: l �� f/ - � at -.� E21bS , O er/Autho ' ed Agent Signature Dat (Revised 1;11/2019) Page 1-Application